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Congenital duodenal obstructions are a group of inborn conditions that cause obstruction of the lumen of the duodenal segment of the small intestine, impeding the passage of food and gastric juices. The condition may have intrinsic etiologies, such as duodenal atresia (most common) and/or extrinsic etiologies, such as an annular pancreas. The hallmark of duodenal obstruction is bilious vomiting. The condition can be diagnosed through prenatal or postnatal ultrasound. Associated anomalies, including congenital heart disease, are common. Treatment includes fluid resuscitation and surgical duodenoduodenostomy.

Peptic Ulcer Disease

Peptic ulcer disease (PUD) refers to the full-thickness ulcerations of duodenal or gastric mucosa. The ulcerations form when exposure to acid and digestive enzymes overcomes mucosal defense mechanisms. The most common etiologies include Helicobacter pylori (H. pylori) infection and prolonged use of non-steroidal anti-inflammatory drugs (NSAIDs). Patients may be asymptomatic or may present with abdominal pain, nausea, and early satiety. Peptic ulcer disease typically responds well to medical treatment consisting of H. pylori eradication, eliminating risk factors, and proton pump inhibitors (PPIs). If left untreated, it can lead to bleeding, perforation, gastric outlet obstruction, and gastric cancer.

Gastritis

Gastritis refers to inflammation of the gastric mucosa. Gastritis may occur suddenly (acute gastritis) or slowly over time (chronic gastritis). Gastritis may be asymptomatic or with symptoms, including burning abdominal pain (which either worsens or improves with eating), dyspepsia, nausea, and vomiting. The most common etiologies for gastritis are Helicobacter pylori infection and autoimmune disease. Chronic gastritis is a risk factor for gastric cancer. Management involves the use of proton pump inhibitors with antibiotics (in case of H. pylori infection), avoidance of offending agents, and replacement of associated deficiencies.

Gastrointestinal Bleeding

Gastrointestinal bleeding (GIB) is a symptom of multiple diseases within the gastrointestinal (GI) tract. Gastrointestinal bleeding is designated as upper or lower based on the etiology’s location to the ligament of Treitz. It is more common to have bleeding in the upper GI tract, with peptic ulcer disease being the most frequent cause. Depending on the location of the bleeding, the patient may present with hematemesis (vomiting blood), melena (black, tarry stool), or hematochezia (fresh blood in stools). Some patients presenting with GIB can be hemodynamically unstable and require emergent stabilization and evaluation. The source of the bleed can often be located and treated with endoscopy.

Gastric Cancer

Gastric cancer is the 3rd-most common cause of cancer-related deaths worldwide. The majority of cases are from adenocarcinoma. The modifiable risk factors include Helicobacter pylori infection, smoking, and nitrate-rich diets. Hereditary syndromes, pernicious anemia, and prior partial gastrectomy are among the endogenous risk factors. When symptoms such as epigastric fullness, vomiting, and weight loss occur, it is likely that the cancer is in the advanced stage. Diagnosis is confirmed with esophagogastroduodenoscopy and biopsy. Imaging studies and laparoscopy aid in determining the cancer stage. Consequently, staging dictates the management approach. Management consists of gastrectomy and chemoradiotherapy. Most cases are diagnosed in late stages, indicating a generally poor prognosis.

Zollinger-Ellison Syndrome — Presentation, Diagnosis, Therapy

Zollinger-Ellison syndrome is one of the rare conditions that affect the duodenum or the pancreas. Tumors (gastrinomas) form in the duodenum or the pancreas, which secrete huge amounts of gastrin leading to excess acid production in the stomach. This excess acid results in the formation of related symptoms as well as peptic ulcers.

Dumping Syndrome — Causes and Treatment

Dumping syndrome, or “too rapid drainage of the stomach,” is a condition most often found in patients post-gastrectomy. Symptoms of this condition can be separated into vasomotor symptoms (such as palpitations, flushing or diaphoresis) and abdominal symptoms (such as diarrhea, nausea or cramps). The symptoms often resolve within several months. Medication is often helpful and surgical intervention is rarely necessary.

Gastroparesis — Causes, Diagnosis and Diet

Gastroparesis is defined as a chronic motility disorder where there is a delayed emptying of the stomach without an apparent mechanical obstruction. Usually, both solids and liquids are affected. Gastroparesis is usually of undetermined causes, but can also be linked to previous abdominal surgeries or diabetes mellitus. Symptoms include nausea, vomiting and early satiety. Once diagnosed, the patient is instructed to follow a diet that has more liquid, promotility agents could be prescribed and antiemetics are used for symptomatic relief.

Angiodysplasia — Symptoms and Treatment

Angiodysplasia describes abnormal vascular malformations found in the gastrointestinal (GI) tract, especially in the cecum and right colon. These malformations are prone to bleed and may be responsible for painless hematochezia, melena and concomitant anemia. Diagnosis can be made by direct visualization during endoscopy or angiography. Treatment consists of endoscopic interventions, including embolization and coagulation, antifibrinolytic medications and surgery as a last resort.

Helicobacter

Helicobacter pylori is a gram-negative bacterium that causes gastric infection. It is the most well known and clinically significant species of Helicobacter. Transmission is believed to occur by ingestion of contaminated food or water; therefore, a higher prevalence of infection is seen in areas with poor sanitation. Certain bacterial features contribute to the pathogenicity of H. pylori: urease production (allowing survival in an acidic environment), motility (permitting movement to the gastric epithelium), and several toxins (creating local damage and inflammation). Chronic infection with H. pylori can lead to peptic ulcer disease or even gastric cancer in severe cases.

Gastrointestinal Bleeding 01:46 min

Gastrointestinal Bleeding 2 quiz questions

Gastrointestinal Bleeding 2 articles
Peptic Ulcer Disease 10:22 min

Peptic Ulcer Disease 5 quiz questions

Peptic Ulcer Disease 1 article
NSAIDs Induced Peptic Ulcer Disease 04:51 min

NSAIDs Induced Peptic Ulcer Disease 3 quiz questions

NSAIDs Induced Peptic Ulcer Disease 2 articles
Helicobacter Pylori Infection 05:01 min

Helicobacter Pylori Infection 3 quiz questions

Helicobacter Pylori Infection 1 article
Zollinger-Ellison Syndrome 08:14 min

Zollinger-Ellison Syndrome 4 quiz questions

Zollinger-Ellison Syndrome 1 article
Stress Ulcer 03:06 min

Stress Ulcer 2 quiz questions

Stress Ulcer 1 article
Autoimmune and Chronic Gastritis 05:11 min

Autoimmune and Chronic Gastritis 3 quiz questions

Autoimmune and Chronic Gastritis 1 article
Stomach Cancer 10:45 min

Stomach Cancer 5 quiz questions

Stomach Cancer 1 article
Gastric Lymphoma 02:38 min

Gastric Lymphoma 4 quiz questions

Gastric Lymphoma 1 article
Gastric Polyps 01:28 min

Gastric Polyps 2 quiz questions

Gastric Polyps 1 article
Gastric Dysmotility Syndromes: Gastroparesis 01:33 min

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Gastric Dysmotility Syndromes: Gastroparesis 1 article
Gastric Dysmotility Syndromes: Dumping Syndrome 02:56 min

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Gastric Dysmotility Syndromes: Dumping Syndrome 1 article
Duodenal Atresia 05:02 min

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Duodenal Atresia 1 article

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Stomach and Duodenum Diseases

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Your Educators of course Stomach and Duodenum Diseases

Carlo Raj, MD

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